Job Description
- Manage medical prices that represent doubtlessly high-greenback, excessive-chance, or excessive-visibility worries to our customers and their membership requiring the analysis of value, long-term and quick-, and as wished, negotiating.
- Evaluate clinical declare submissions with a high level of element to aid cost containment measures as diagnosed, and create an internal community of aid to create efficient resolution to high threat objects.
- Provide consultative guide for our customers because it pertains to the Meritain Cost Management packages, at a detailed level, and to barter, settle, or reconcile medical charges because it pertains to Meritain individuals/customers.
- Establish effective and clear verbal exchange to Meritain’s Client Management groups to make certain an stronger development in their customers’ wishes to in addition broaden those relationships for purchaser retention functions.
- Independently get right of entry to essential assets to formulate selection-making because it relates to service-associated value-containment thru interaction of Claims vicinity, Stop Loss, Client Relations, Quality Assurance, and many others.
Qualification and Experience:
- Five+ years enjoy in the HealthCare Industry (Claims/Coding/Edit Development, scientific repayment policy improvement preferred), and one or extra of the following methodologies: monetary strategic evaluation, strategic business making plans, and/or risk control consulting.
- Command of Coding, Medicare edits, widespread software program edits, Facility (UB) and Professional (HCFA/CMS) formatted declare submissions
- Contracting, negotiating, and reconciliation of disputes with interpersonal control of danger.
- Data Management abilties with capacity to evaluate, as well as generate, reports as needed to outline a centered need—an analytical and statistical history is preferred.
- Project work, or Business Analysis backgrounds with recognized teamwork skills and validated success.
- Familiarity with Fraud, Waste and Abuse schemes inside the HealthCare Industry.
- Certification in procedural coding or an experienced medical billing/reporting or scientific evaluate heritage.
- The maximum stage of training preferred for candidates on this role is a Bachelor's diploma or equivalent experience.
Company Profile:
Salary: Not disclosed
Industry: Medical / Healthcare / Hospital
Functional Area:
Role Category: Consultant
Employment Type: Full time
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